| Efficacy of Shirodkar cervical suture in securing hemostasis following surgical evacuation of Cesarean scar ectopic pregnancy. | |
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MedLine Citation:
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PMID: 17559184 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To assess the efficacy of a Shirodkar cervical suture in arresting hemorrhage following surgical removal of a Cesarean scar ectopic pregnancy. METHODS: The study included women with an ultrasound diagnosis of Cesarean scar ectopic pregnancy who were scheduled for surgical evacuation. After administration of general anesthetic, a Shirodkar cervical suture was inserted using the standard surgical technique. The suture was left untied and the Cesarean scar pregnancy was evacuated under ultrasound guidance using suction curettage. Once the pregnancy had been successfully removed, the suture was tied and 500 microg ergometrine was administered intravenously to ensure uterine contraction. The patients were prescribed prophylactic antibiotics and the suture was removed 7 days later in the outpatient setting, under local anesthetic. RESULTS: Over a 4-year period a total of 33 Cesarean scar pregnancies were diagnosed, and 28 (85%) had surgical evacuation. A cervical suture was necessary to achieve hemostasis in 22/28 (79%; 95% CI, 64-94) cases. In the remaining 6/28 (21%; 95% CI, 6-36) cases, the bleeding was minimal and the suture was not tied. The median estimated intraoperative blood loss was 50 (range, 50-1500) mL. Six of 28 (21%; 95% CI, 6-36) women suffered blood loss > or = 300 mL and two (7%; 95% CI, 0-17) required blood transfusion. One woman (5%; 95% CI, 0-14) required repeat surgery because of retained products of conception. There were no other significant complications and the uterus was preserved successfully in all cases. CONCLUSIONS: Insertion of a Shirodkar cervical suture during the evacuation of a Cesarean scar pregnancy is an effective method for securing hemostasis; it minimizes the need for blood transfusion and ensures preservation of fertility. |
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Authors:
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D Jurkovic; J Ben-Nagi; D Ofilli-Yebovi; E Sawyer; S Helmy; J Yazbek |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology Volume: 30 ISSN: 0960-7692 ISO Abbreviation: Ultrasound Obstet Gynecol Publication Date: 2007 Jul |
Date Detail:
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Created Date: 2007-07-02 Completed Date: 2008-02-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9108340 Medline TA: Ultrasound Obstet Gynecol Country: England |
Other Details:
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Languages: eng Pagination: 95-100 Citation Subset: IM |
Affiliation:
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Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK. davor.jurkovic@kcl.ac.uk |
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| MeSH Terms | |
Descriptor/Qualifier:
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Abortion, Induced
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methods Adult Cesarean Section / adverse effects* Cicatrix / complications* Female Humans Pregnancy Pregnancy, Ectopic / etiology, ultrasonography* Ultrasonography, Prenatal / methods Uterine Hemorrhage / prevention & control* Vacuum Curettage / methods*, standards |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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